Supv Regional Care Mgmt -SCMG - Sharp Corporate Offices - FT - Days

Shift: 8 AM – 5 PM, 8-hour shifts, no weekends, no on-call.

Pay

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position: $72.29 – $93.28 – $104.47 per hour. The actual pay rate and pay grade will depend on years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, and employer business practices.

Responsibilities

• Supervise the effective implementation of Ambulatory Case Management (ACM) programs, managing patients across the care-management spectrum.
• Oversee operational planning consistent with existing policies and procedures.
• Track, trend, and analyze ACM data; streamline and improve programs; facilitate provider education; support Medical Directors; and collaborate on interdepartmental activities.
• Develop and implement new programs under the direction of the Manager of Integrated Care Management and Director of Health Services.
• Participate in the development of annual ACM plans and corrective-action plans related to health-plan audits, NCQA, and other regulatory bodies.
• Collaborate with Quality, Compliance, and Training departments to integrate processes consistent with health-plan, NCQA, DMHC, and CMS requirements.
• Supervise ACM staff and operational processes in accordance with NCQA, DMHC, CMS, and health-plan requirements.
• Oversee ACM and Utilization Management (UM) processes, ensuring staff access to needed information and tools.
• Maintain up-to-date tools aligned with regulatory requirements and internal processes.
• Establish and enforce policies, procedures, and training plans for ACM team activities.
• Coordinate with Health Services Quality and Compliance to implement training and verify adherence to quality and compliance parameters.
• Implement and maintain reporting systems for operational and utilization outcome indicators.
• Participate in strategic planning to implement organizational vision and service-culture initiatives.
• Establish quality goals, connecting vision to actions and long-term strategies.
• Recognize physician and patient needs, initiating opportunities for improvement.
• Collaborate with physicians to address operational issues and promote positive outcomes in a managed healthcare setting.
• Lead team members to facilitate quality healthcare services, utilizing strong communication, problem-solving, and critical-thinking skills.
• Direct and collaborate with peers to assist in the case-management process.
• Promote team performance goals and monitor progress toward departmental goals.
• Assist in ongoing education of providers, physicians, and their office staff.
• Implement action plans to improve referral processing under ACM management direction.
• Enforce policies and procedures for all Case Management activities.
• Maintain ongoing analysis of program performance, monitoring trends and opportunities for enhancement.
• Document ACM processes according to SCMG policies and procedures.
• Collaborate with other disciplines/departments to resolve identified issues and improve operational flow.
• Facilitate ACM staff and provider collaboration.
• Operationalize efficient ambulatory case-management and referral-management workflows to ensure timely patient care.
• Identify areas of non-compliance and provide input on actions for improvement.
• Establish and maintain operational documents such as policies, procedures, and desktop guides.
• Collaborate with vendors to provide in-services for staff.

Human Resource Management

• Complete 90-day and annual performance reviews per Sharp guidelines.
• Provide feedback on employee performance and facilitate progress toward annual performance goals.
• Ensure employee files are current and complete, including annual TB testing, safety training, compliance training, and HIPAA testing.
• Manage and assist staff to resolve attendance, performance, learning, and behavior issues through feedback, counseling, corrective action, and goal-setting.
• Hire staff for the department per the department plan.
• Orient and mentor staff into new roles, ensuring achieved competencies.
• Ensure accuracy in new-employee onboarding, including granting systems access (e.g., EPIC, OnBase, health-plan websites, EHR).
• Increase retention rate (or reduce turnover) of staff.
• Lead initiatives that improve teamwork and build more effective relationships.
• Decrease occurrences of unsafe work practices and worker injuries.
• Arrange team coverage for ACM teams during staff absences, demonstrating flexibility and competence to serve as a "float" as needed.
• Support ergonomic improvement initiatives, teaching, and enforcing compliance with measures designed to reduce employee injury.
• Provide training and assistance to staff; mentor others in developing new skills and assuming new responsibilities.
• Coordinate staffing schedules to assure adequate department coverage.
• Complete special projects as assigned by the Manager and/or Director.

Leadership

• Lead groups in developing and implementing strategic plans to realize organizational vision and service-culture initiatives.
• Establish specific quality goals, connecting vision to necessary actions and long-term strategies.
• Recognize physician and patient needs, initiating opportunities for improvement.
• Collaborate with other disciplines/departments to resolve daily operational issues.
• Facilitate staff in prioritizing and problem-solving daily operational issues.
• Demonstrate resolution of operational issues with targeted outcomes as negotiated with the manager.
• Utilize team-building skills to provide direction, goal-setting, and attainment of goals.
• Conduct team meetings, documenting agendas and minutes on a consistent schedule.

Quality and Productivity Performance

• Monitor and manage staff deviations from team quality and productivity goals.
• Conduct and report quarterly performance audits and results.
• Establish and maintain quarterly staff meetings to review progress toward quality and productivity goals.

System Configuration and Testing

• Plan and develop operating systems to manage SCMG operational and business objectives through ACM queues and workflows.
• Participate in the development and implementation of software functionality, upgrades, and system integration.
• Coordinate testing efforts for new and current software functionalities and applications.
• Oversee the process of identifying, reporting, troubleshooting, and resolving system problems.
• Analyze the impact of software changes on accuracy and productivity.
• Oversee ACM ambulatory CM and UM process workflows from an application perspective and staff adherence.

Professional Development

• Maintain competence in ambulatory case management, referral management, and care coordination standards.
• Keep current knowledge of applicable accreditation and regulatory statutes related to healthcare, managed care, and case-management practice.
• Serve as a resource and mentor to Health Services teams.
• Attend and actively participate in department/team process and quality-improvement activities.

Program Improvement

• Maintain ongoing analysis of program performance, monitoring trends and opportunities for enhancement or expansion.
• Provide expertise and consultation in developing services, programs, marketing strategies, and business planning.
• Consult and liaise with other programs, agencies, and consultants as appropriate.
• Collaborate with other disciplines/departments to resolve identified issues.

Requirements

• Bachelor’s degree in nursing or a healthcare-related field.
• 3 years of experience in patient-care settings such as acute care (ICU or Intermediate care units), Medical-Surgical Nursing, and/or Home Health.
• 3 years of medical-management experience, preferably in managed care.
• California Registered Nurse (RN) license – required.

Preferred Qualifications

• 2 years of leadership experience, preferably in a managed-care setting.
• Utilization, Case Management, or Quality Management certification.

Skills

• Effective interpersonal skills: strong verbal, written, and presentation abilities.
• Ability to work well with staff from various educational and professional backgrounds to achieve common goals.
• Accepts accountability for performance and decisions.
• Thorough computer knowledge, including online databases and personal computer skills.
• Knowledge of local and national resources for use in the Care Management process.
• Strong organizational skills with the ability to work under pressure and with conflicting priorities.
• Ability to read, speak, and hear English clearly.
• Occasional travel between Sharp HealthCare facilities and provider offices; must provide own transportation.
• Demonstrated leadership skills.